The city of Portland issued a lengthy defense of its needle exchange program on Friday after advocates criticized officials for maintaining restrictive policies during the coronavirus pandemic.

City officials say there has been no need to drop its policy restricting the number of syringes provided to people enrolled in the program despite guidance from public health experts that it is limiting access to clean needles and putting people at risk of contracting COVID-19.

The statement issued Friday also expressed concern that some people who had been exchanging needles through the program run out of its India Street Clinic were using them “to facilitate the operation of unsanctioned needle exchange programs, something that is not permitted under the state’s program rules.”

Gov. Janet Mills issued an executive order on March 30 that allows exchange programs to provide clients with as many clean syringes and other supplies as needed, taking the step to help contain the spread of the coronavirus and ensure access to clean needles during the pandemic. Before the order, programs could only give clients as many clean syringes as the number of used syringes they turned in. The order also allows programs to expand hours and the locations of mobile exchanges and outreach efforts.

Such programs help prevent diseases such as hepatitis C and HIV, which can be spread through needle-sharing, and connect intravenous drug users with addiction treatment and other services. Mills’ order, which was intended to reduce the number of times clients have to go to an exchange, was in line with guidance from the U.S. Centers for Disease Control and Prevention and was hailed by the American Medical Association as a model for other states.

The debate over the city’s policy comes as overdose deaths in 2020 were on pace to surpass the high of 417 set in 2017. The final numbers for last year have not yet been released.

Portland’s city-run program is the only one in the state to maintain a strict one-for-one exchange policy and not expand its mobile exchange efforts.

“We encourage clients of our Needle Exchange Program to visit us often, in part, to ensure that they are equipped with the life-saving overdose reversal drug Narcan,” the city’s written statement said.

Kristen Dow, the director of the city’s health and human services program, said that out of the roughly 20 recommendations the U.S. CDC gives exchange programs to prevent COVID-19 infection, waiving the one-for-one requirement is the only one the city’s exchange is not following.

“Syringe exchange programs are so much more than providing clean needles; they are a bridge to life-saving resources for the clients we serve,” Dow said.

Dow’s statement was part of a city release that also highlighted an audit of the program conducted in November after the city noticed an increase in the number of syringes being carried by people staying at its homeless shelter. A city spokesperson said two shelter clients had “in excess of 100” syringes and noted an increase in the number of used syringes being found in public spaces.

The audit found that staff had not been abiding by the one-for-one limit and that individuals were using the exchange to operate an unsanctioned private needle exchange program, the city said.

Although the city did not name those people, a representative of a group called the Church of Safe Injection told the Press Herald that its volunteers have been operating in Portland since March because the city was not meeting the need. The nonprofit, which declares harm reduction to be a religion to justify its work as a non-sanctioned needle exchange program, provides clean syringes and the overdose antidote naloxone through mobile outreach. The group had been getting clean syringes from the city clinic until the city ended the arrangement in December, following the audit.

“The findings of the investigation were deeply disappointing,” Dow said. “As we move forward, the city is committed to more thoroughly reviewing its Needle Exchange Program data to ensure that our essential harm-reduction services continue to meet the needs of our clients as our staff work to provide life-saving resources for those living with substance use disorders.”

While the city said it believes the existing policy is working, it will seek feedback from clients of the program “in an effort to further evaluate the community’s needs.”

Courtney Pladsen, a clinical director for the National Health Care for the Homeless Council and a local substance use treatment provider, called the city’s response “unfortunate.” She said studies have shown restrictive syringe exchange policies lead to less client engagement and increased risk for infections from needle-sharing. And she said the city is conflating drug use with homelessness, calling it a dangerous narrative.

“I hope the city considers using all of its resources to not simply maintain the status quo, which is leading to record overdose deaths, but instead consider all possible avenues to save lives, including increasing access to syringes, substance use treatment, and establish an evidence-driven safe consumption site,” she said.

The city’s release came two days after the council and the city’s attorney met for nearly two hours in private to discuss the city’s Needle Exchange Program. City officials have refused to provide more details about the topic of the meeting or why it needed to be discussed in private with their attorney, without members of the media or the public being present.

The Portland Press Herald objected, both in writing and verbally, to the closed-door session, which was announced Tuesday in response to a story about the Portland exchange being the only program in the state to not relax its one-for-one policy. Adding the executive session effectively cut off any public discussion of the issues raised by critics of the city’s policy.

Mayor Kate Snyder informed attendees at Wednesday’s virtual council meeting that they could not comment on the exchange during an open comment period because such comment is limited to items that do not appear on the agenda.

On Friday, Snyder declined to comment beyond the city’s written statement, suggesting the council had no role to play in setting policy at the needle exchange.

“This is an operations issue within the HHS department overseen by the city manager,” Snyder said in a text message.

The city’s statement Friday said there was “no dramatic shift” in the number of clients served in the last month after city reiterated the need to follow the one-for-one policy.

However, the city’s preliminary annual report shows that the exchange is served 162 fewer clients last year, after years of steady growth. According to state reports, the number of people enrolled in Portland’s program increased totaled 3,328 people in 2020.

City Councilor Tae Chong, who leads the council’s health and human services committee, said the city’s data shows that the one-for-one policy is working and it’s not a barrier for clients.

“We would change the policy if we saw a glaring need,” Chong said. 

Chong suggested that the drop in needle exchange clients may be due to the rise in the use of methamphetamines.

Pladsen, the substance use treatment provider, dismissed that theory, saying that such a shift would increase the number of needles being distributed.

“Absolutely not,” Pladsen said. “People inject meth as well as other substances (heroin, Suboxone, fentanyl, etc). Yes, there is a surge of meth use, but this should drive up syringe exchange, not decrease it.”

Pladsen said her clients report having trouble getting clean syringes and she’s observed an increase in skin infections associated with needle sharing. She said clients have reported that they no longer feel comfortable accessing services at India Street, since longtime staff with whom they had built relationships have left.

Volunteers with the needle exchange also report that clients have said it’s more difficult to access clean syringes.

The city’s exchange also is not fully staffed.

Zoe Brokos, the former substance use prevention and harm-reduction services coordinator, said she resigned in November after being placed on administrative leave at the onset of the city’s audit. She said three other staffers resigned between July and December. Brokos has declined to discuss the circumstances of her departure.

City Hall Communications Director Jessica Grondin said the city budget contains two full-time positions for the needle exchange, plus part of the program coordinator position, all of which are empty. She said Bridget Rauscher, the city’s chronic disease prevention manager, is currently running the program with a grant-funded patient navigator.

Grondin defended the city’s policy decision by pointing to an increase in the number of discarded needles found in public, including “a number of tragic incidents.” She said those include two staff members who were stuck by needles while working in the parks and a woman whose daughter was stuck by a needle.

Advocates, however, pointed to a different tragedy.

“We do not believe anything is more tragic than the suffering and preventable death city residents – particularly those who are unhoused – have experienced throughout this pandemic,” the Portland Overdose Prevention Society wrote in social media. “We call on the city to work with community-based harm-reduction organizations and directly impacted people to identify true, workable solutions that protect physical health and well-being.”

Note: A headline on this article was updated on Jan. 23 to remove a statement incorrectly attributed to Kristen Dow.